Management of Bipolar Disorder
Bipolar disorder is a common mood disorder characterized by extreme changes in an individual’s mood. The manic episodes associated with bipolar disorder include high energy, reduced need to sleep as well as a loss of touch with reality. Advanced practice nurses should understand the treatment options available for a mood disorder. The paper discusses critical medication decision points for an Asian woman with Bipolar Disorder.
Decision Point One: Begin Lithium 300mg orally BID
The selected decision for the patient is to begin lithium 300mg orally BID. The rationale for the selection of the decision is that lithium is a first-line mood stabilizer and is thus preferred for bipolar disorder. The medication is distributed widely in the central nervous system and interacts with neurotransmitters and receptors. The interaction decreases norepinephrine and increases the synthesis of serotonin (Moreira & Geoffroy, 2016). By prescribing the medication for the patient, I was hoping to help in the stabilization of the patient’s mood and improve bipolar symptoms such as loss of touch with reality. The results of the decision were different from what I anticipated. After four weeks, the patient returned with the same presentation and stated that she only took the medications when she felt like. She was still out of touch with the reality that she was bipolar.
Decision Point Two: Assess the rationale for non-compliance
The second decision point was to assess the patient’s non-compliance with lithium and to educate her on the drug effects and pharmacology. The rationale for opting for the decision is because the patient stated that she only took the medication when she felt like it. Her symptoms had not improved because of non-adherence. By making the decision, I look forward to determining why the patient was complying with the medication. I also anticipated educating the patient about the side effects of the medication. I managed to educate the patient on the importance of medication compliance to relieve the symptoms. However, the results of the decision were different from what I anticipated. The patient returned to the clinic after 4 weeks and the stated that the medication makes her nauseated and gives her diarrhea. She said that she often stopped taking the medications until the symptoms abated. She would experience the same side effects after re-starting lithium therapy.
Decision Point Three: Change Lithium to sustained-release preparation at the same dose and frequency
The third decision point is to change Lithium to sustained-release preparation at the same dosage and frequency. The rationale for the sustained release preparation is to relieve the patient of the side effects of the medication such as nausea and diarrhea (Malhi & Outhred, 2016). Sustained-release preparation will thus help in stabilizing the patient’s mood while minimizing the side effects associated with the use of the medication (Moreira & Geoffroy, 2016). Changing Lithium to sustained-release preparation will equally help in controlling mania. It is important to monitor the patient after the third decision.
References
Malhi, G. S., & Outhred, T. (2016). Therapeutic mechanisms of lithium in bipolar disorder: recent advances and current understanding. CNS drugs, 30(10), 931-949. https://doi.org/10.1007/s40263-016-0380-1
Moreira, J., & Geoffroy, P. A. (2016). Lithium and bipolar disorder: impacts from molecular to behavioral circadian rhythms. Chronobiology International, 33(4), 351-373. https://doi.org/10.3109/07420528.2016.1151026